3. Professor Diakonova University College Oslo, Norway Katharine Kolcaba, RN, MSN, PhD
Associate Professor The University of Akron, Ursuline College Akron, Ohio Elizabeth R. Lenz,
PhD, RN Professor Emeritus The Ohio State University College of Nursing Columbus, Ohio
Marjorie McCullagh, PhD, RN, FAAOHN, FAAN Associate Professor and Director 9
Occupational Health Nursing Program University of Michigan School of Nursing Ann Arbor,
Michigan Renee Milligan, MD Term Professor, School of Nursing George Mason University
Fairfax, Virginia Sandra J. Peterson, PhD, RN Professor Emerita Bethel University St. Paul,
Minnesota Accreditation Partner NurseTim, Inc. Waconia, Minnesota Celeste R. Phillips,
PhD, RN, CPON Assistant Professor Indiana University School of Nursing Indianapolis,
Indiana Mertie L. Potter, DNP, PMHNP-BC, PMHCNS-BC Professor MGH Institute of Health
Professions Boston, Massachusetts Nurse Practitioner MVCA Nashua, New Hampshire Linda
C. Pugh, PhD, RNC, CNE, FAAN Director, Graduate Programs in Nursing York College of
Pennsylvania York, Pennsylvania Barbara Resnick, PhD, CRNP, FAAN, FAANP Professor
Sonya Ziporkin Gershowitz Chair in Gerontology 10 University of Maryland, School of
Nursing Baltimore, Maryland Kristin E. Sandau, PhD, RN Professor of Nursing Bethel
University St. Paul, Minnesota Marjorie A. Schaffer, PhD, RN Professor Emerita Bethel
University St. Paul, Minnesota Ellen D. Schultz, PhD, RN, CHTP, AHN-BC Professor of Nursing
Metropolitan State University St. Paul, Minnesota Marjorie Webb, PhD(c), DNP, APRN, C-NP
Associate Professor Metropolitan State University St. Paul, Minnesota Danuta M. Wojnar,
PhD, RN, MEd, FAAN Associate Professor Seattle University and Associate Dean for
Undergraduate Programs Seattle, Washington Contributors to the Third Edition Laurel Ash,
DNP, CNP, RN Assistant Professor College of St. Scholastica Duluth, Minnesota 11 Georgene
Eakes, EdD, RN Professor Emerita College of Nursing East Carolina University Director,
Clinical Education Center for Learning and Performance Pitt County Memorial Hospital
Greenville, North Carolina Audrey Gift, PhD, RN, FAAN Professor Emeritus Michigan State
University, College of Nursing East Lansing, Michigan Marion Good, Connection Between
Nursing Theory And Practice PresentationPhD, FAAN Professor Emerita, Frances Payne
Bolton School of Nursing Case Western Reserve University Cleveland, Ohio Visiting
Professor, Hong Kong University School of Nursing, 2010â2011 Joan E. Haase, PhD, RN,
FAAN Holmquist Professor of Pediatric Oncology Nursing Department of Clinical Nursing
ScienceCo-Director, The RESPECT Signature Center at IUPUI Indiana University
Indianapolis, Indiana Barbara Hoglund, EdD, MSN, RN, FNP-C Associate Professor of Nursing
Bethel University St. Paul, Minnesota Trine Klette, PhD Associate Professor Diakonova
University College Oslo, Norway Katharine Kolcaba, PhD, RN, MSN 12 Associate Professor,
Emerita and Visiting Professor The University of Akron, Ursuline College Akron, Ohio
Elizabeth R. Lenz, PhD, RN, FAAN Dean, Professor College of Nursing The Ohio State
University Columbus, Ohio Marjorie McCullagh, PhD, RN, APHN-BC, COHN-S Assistant
Professor and Director, Occupational Health Nursing Program School of Nursing University
of Michigan Ann Arbor, Michigan Renee Milligan, PhD, RN Associate Professor, School of
Nursing Georgetown University Washington, District of Columbia Mertie L. Potter, DNP,
PMHNP-BC, PMHCNS-BC Professor MGH Institute of Health Professions Boston,
Massachusetts Nurse Practitioner MVCA Nashua, New Hampshire Linda C. Pugh, PhD, RNC,
CNE, FAAN Director, Graduate Programs in Nursing York College of Pennsylvania York,
4. Pennsylvania Barbara Resnick, PhD, CRNP, FAAN, FAANP Professor Sonya Ziporkin
Gershowitz Chair in Gerontology University of Maryland, School of Nursing 13 Baltimore,
Maryland Kristin E. Sandau, PhD, RN Professor of Nursing Bethel University St. Paul,
Minnesota Marjorie A. Schaffer, PhD, RN Professor Emerita Bethel University St. Paul,
Minnesota Ellen D. Schultz, PhD, RN, CHTP, AHN-BC Professor of Nursing Metropolitan State
University St. Paul, Minnesota Danuta M. Wojnar, PhD, RN, MEd, FAAN Associate Professor
Seattle University and Associate Dean for Undergraduate Programs Seattle, Washington
Reviewers Kim Siarkowski Amer, MD Associate Professor DePaul University, School of
Nursing Chicago, Illinois Lori Bork, PhD, MSN, RN, CCRN Professor Dakota Wesleyan
University Mitchell, South Dakota Julie Brandy, PhD, RN, FNP-BC 14 Assistant Professor
College of Nursing and Health Professions Valparaiso University Valparaiso, Indiana Cynthia
Brown, DNS, RN, AHN-BC, CNE Assistant Professor University of West Georgia Tanner
Health System School of Nursing Carrollton, Georgia Maria A. Connolly, PhD, CNE, ANEF,
FCCM Professor of Nursing Adjunct Marcella Niehoff School of Nursing Loyola University
Chicago Chicago, Illinois Beth D. Crouch, MSN, RN, BS Assistant Professor of Nursing
Milligan College Milligan College, Tennessee Karen V. Duhamel, MSN, MS, RN Instructor of
Nursing The University of Hartford West Hartford, Connecticut Tresa Kaur Dusaj, PhD, RN-
BC, CNE, CHSE, CTN-A Faculty Program Director Excelsior College Albany, New York
Michelle Edmonds, PhD, FNP-BC, CNE Professor of Nursing Jacksonville University
Jacksonville, Florida 15 Susan Sweat Gunby, PhD, RN Professor Georgia Baptist College of
Nursing Mercer University Atlanta, Georgia Kathryn Van Dyke Hayes, PhD, RN, CNE
Professor and Director of Graduate Nursing Programs Holy Family University Philadelphia,
Pennsylvania Phyllis Jeans, MSN, RN Assistant Professor Baptist College of Health Sciences
Memphis, Tennessee Melanie Kalman, PhD, RN Professor, College of Nursing Upstate
Medical University Syracuse, New York Theresa A. Kessler, PhD, RN, ACNS-BC, CNE
Professor of Nursing and Kreft Endowed Chair for the Advancement of Nursing Science
Valparaiso University Valparaiso, Indiana Donna Koestler, EdD, MSN, RN Assistant
Professor of Nursing Delta State University Cleveland, Mississippi Regina Lederman, RN,
BSN, MN Ed, MA, PhD, FAAN Professor, University of Texas Medical Branch at Galveston
School of Nursing Graduate School of Biomedical Sciences Adjunct Professor, UT-Health
Science Center School of Public Health 16 Galveston, Texas Jerrilee LaMar, PhD, RN, CNE
Associate Professor of Nursing Dunigan Family School of Nursing and Health Sciences
University of Evansville Evansville, Indiana Patricia A. Mattingly, Connection Between
Nursing Theory And Practice PresentationMD Associate Professor of Nursing Keuka College
Keuka Park, New York Ann M. Mayo, DNSc, RN Professor of Nursing University of San Diego
San Diego, California Diane B. McNaughton, PhD, APHN-BC Associate Professor Rush
University College of Nursing Chicago, Illinois Bernita Missal, PhD, RN Professor Bethel
University St. Paul, Minnesota Aroha Page, PhD, (UCSF), MPhil(N), BA, BScN, Grad Dip
Health Sci, RN, FRCNA Associate Professor Nipissing University North Bay, Ontario, Canada
Carole A. Pepa, PhD Professor Valparaiso University 17 Valparaiso, Indiana Kathy Reavy,
PhD, RN Professor Boise State University Boise, Idaho Liz Seabrook, RN, MScN, DOHN BScN
Professor Lambton College Sarnia, Ontario, Canada Nuananong Seal, PhD, RN Professor
UWâMilwaukee, College of Nursing Milwaukee, Wisconsin Denice Kopchak Sheehan, PhD,
5. RN Associate Professor Kent State University College of Nursing Kent, Ohio Christie Shelton,
PhD, RN, CNE Dean/Associate Professor Jacksonville State University Jacksonville, Alabama
Phyllis Skorga, PhD, RN, CCM Professor of Nursing Arkansas State University Jonesboro,
Arkansas Amy Rex Smith, PhD Professor Belhaven University Jackson, Mississippi 18 Julie
Strunk, PhD, RN Professor James Madison University Harrisonburg, Virginia Angela
Thompson, DNP, BC-FNP, BC-WHNP Assistant Professor of Nursing Director FNP Program
Wheeling Jesuit University Wheeling, West Virginia Ching Eng H. Wang, PhD, APN, NP-C
Associate Professor of Nursing North Park University Chicago, Illinois Debra J. Bohlender
Welch, PhD, RN-BC Assistant Professor, Post-Licensure (RN-BSN) Division Indiana
Wesleyan University, School of Nursing Marion, Indiana 19 Preface Middle range theories
have understandably emerged as the focus of knowledge development in nursing with a
broad acceptance of the need to develop middle range theories to support nursing practice.
There is a dynamic relationship between theory, research, and practice. Research is a
source of theory development, and theory is a source of research questions. Theory is used
to improve practice, and practice is used to generate, test, and refine theories. Basically, it is
by testing the theories through research that the evidence for practice is generated. In this
fourth edition, the change of the title to Middle Range Theories Application to Nursing
Research and Practice better reflects this dynamic relationship with increased emphasis on
applications of middle range theories to practice. We continue to hope that this edition can
serve as a resource for nurse scholars and practitioners, making middle range theories
more accessible and useful. The ultimate goal is the advancement of nursing as a profession
and improving the quality of its practice. With the increase in the number of middle range
theories being developed, determining which to include in this edition is always a challenge.
As for the previous editions, we reviewed published research and practice applications of
theories. We also solicited input from practitioners. The goal was to identify those theories,
though in the middle range of abstraction, are not particularly narrow in their possible
applications. That process resulted in the addition of two middle range theories: the theory
of change and the Experiential Theory of Spiritual Care in Practice. Organization Part I 20
Part I is devoted to an overview of the state of nursingâs body of knowledge and the
processes by which it is evaluated. Chapter 1 introduces the interrelationship between
nursing theory, research, and practice. In addition to a brief discussion of epistemology with
a summary of Carperâs conceptualization of nursesâ ways of knowing, the majority of the
chapter addresses the hierarchy of nursing knowledge. The emphasis, of course, is on the
place of middle range theory within that hierarchy (i.e., paradigm, philosophy, conceptual
framework, and theories). For each component of the hierarchy, the chapter includes a
description of its nature, review of its development, a discussion of its contributions to
nursing knowledge, consideration of controversies related to its nature or use, and
examples of nurse scholarsâ work. Connection Between Nursing Theory And Practice
PresentationThe section devoted to middle range theories includes an expanded and
updated table with multiple examples of middle range theories referenced. Also included is
an expanded discussion of practice or situation-specific theories with a table that provides
recent examples of this level of theory development. Chapter 2 emphasizes the analysis and
evaluation of middle range theories, including issues to consider in the selection of a middle
6. range nursing theory for research purposes. This chapter also describes a brief evaluative
process for theory analysis. Using this evaluation process, readers can compare and
contrast their conclusions about the theory as presented in the chapter with those of a
nurse scholar who has also used this evaluation process. The theory analysis exercises
related to each chapter are available in the Student Resources located on
(http://thepoint.lww.com/Peterson4e). Parts II to VI Parts II to VI are devoted to specific
middle range theories. The selected theories are labeled by their developers or by nurse
scholars as middle range theories and are ones frequently cited in published nursing
research or practice applications. Many of the chapters contain unique nursing theories;
some are borrowed from related disciplines but are, nonetheless, useful to nursing. All
theories in the text, however, have the intrinsic capability to be applied to nursing research
and practice. They address a wide range of phenomena that allow the researcher to
consider a variety of nursing research questions and uses in practice. The theories have
been organized by categories to reflect a general focus of research questions or 21 practice
applications. The categories are not presented as absolute, but more as a guide to direct the
user of the book to the theories that might be most relevant to their issue of interest.
PhysiologicalâPain: Balance of Analgesia and Side Effects; Unpleasant Symptoms
CognitiveâSelf-efficacy, Reasoned Action EmotionalâEmpathy, Chronic Sorrow,
Experiential Theory of Spiritual Care in Practice SocialâSocial Support, Interpersonal
Relations, Attachment IntegrativeâModeling and Role-Modeling, Comfort, Heath-Related
Quality of Life, Health Promotion, Deliberative Nursing Process, AACN Synergy Model,
Resilience, Change Special Features Each theory chapter provides the nurse researcher with
a variety of tools. Key features include the following: Definitions of Key Terms appear at the
beginning of each chapter to define concepts and aid the readerâs understanding of the
theory. Using Middle Range Theories in Research boxes provide examples of how the theory
has been used in published research. These have been updated and reformatted, using an
outline based on the research process. Using Middle Range Theories in Practice boxes
provide examples of theories applied to a specific clinical practice situation. They too have
been reformatted so that the clinical issue and the use of the theory as a foundation for
nursing intervention are clearly identified. Examples of Theory in Practice tables are
included in each chapter. The headings on these tables are similar to the matrix used to
critique research as a basis for evidence-based practice. Critical Thinking Exercises at the
end of each chapter engage readers in analysis of the theory and its application to practice.
Instruments are discussed in the chapters, with specific examples âŠConnection Between
Nursing Theory And Practice Presentation